From: S Hawthorne

3 February 2013

Dear Department of Health,

On 31 January 2013, the Secretary of State for Health approved the downgrade of Lewisham Hospital's accident and emergency department to a "smaller" A&E and the downgrade of the hospital's maternity unit to a mid-wife lead unit.

A number of claims were used to underpin this decision. I would like to request the statistical and clinical evidence behind each of the below statements:

1) The changes to maternity and emergency care would result in the average blue light transfer times in south-east London increasing by one minute

2) Accessing consultant-led maternity services will involve an increase in journey times on average of two to three minutes by private or public transport

3) The new free-standing, midwife-led unit at Lewisham Hospital will be able to deal with a minimum of 10% of existing activity and up to 60% of current activity.

4)The new smaller Lewisham Hospital A&E can continue to see up to 75% of those currently attending Lewisham A&E

5)The overall proposals could save up to 100 lives per year through higher medical standards

I look forward to receiving the information used to underpin the above five statements. If you are unable to provide this information, I would be grateful if you could direct this request to the appropriate individual/organisational body.

Department of Health

5 February 2013

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From: S Hawthorne

9 February 2013

Dear Department of Health,

Just to clarify r.e. my original request, I am well aware that many of the points were taken from advice Mr Hunt received from Sir Bruce Keogh and that the letter from Sir Bruce Keogh is available online.

To be absolutely clear, what I am asking for, under the Freedom of Information Act, is what clinical and statistical evidence Sir Keogh himself based these assertions on.

In terms of the '100 lives saved' claim, which Mr Hunt did not get from Sir Keogh, I would like to know what clinical and statistical evidence Mr Hunt based this assertion on.

From: S Hawthorne

27 February 2013

Dear Department of Health,

With two more days until you are legally required to make a response, just to make my request unequivocally clear, I am asking for the statistical and clinical evidence that was used by either Bruce Keogh or (in the case of the 100 lives claim) Jeremy Hunt, to come to the exact figures stated in my original request.

I am not asking you to direct me to general research on A&Es that was used to support to decision to downgrade the hospital - I want to know the details of the specific calculations that led Bruce Keogh / Jeremy Hunt to these EXACT figures.

To confirm, these figures are (capitalised for emphasis):

1) The changes to maternity and emergency care would result in the average blue light transfer times in south-east London increasing by ONE MINUTE

2) Accessing consultant-led maternity services will involve an increase in journey times on average of TWO TO THREE MINUTES by private or public transport

3) The new free-standing, midwife-led unit at Lewisham Hospital will be able to deal with a minimum of TEN PER CENT of existing activity and up to SIXTY PER CENT of current activity.

4)The new smaller Lewisham Hospital A&E can continue to see UP TO 75% of those currently attending Lewisham A&E

5)The overall proposals could save up to 100 LIVES per year through higher medical standards

“On 31 January 2013, the Secretary of State for Health approved the downgrade of Lewisham Hospital's accident and emergency department to a "smaller" A&E and the downgrade of the hospital's maternity unit to a mid-wife led unit.

A number of claims were used to underpin this decision. I would like to request the statistical and clinical evidence behind each of the below statements."

I then listed five statements cited by Jeremy Hunt.

I later clarified that: “I am not asking you to direct me to general research on A&Es that was used to support to decision to downgrade the hospital - I want to know the details of the specific calculations that led Bruce Keogh / Jeremy Hunt to these EXACT figures.”

The description of the statistical and clinical evidence with regard to two of the statements were vague, inadequate and unacceptable. These statements were:

3) The new free-standing, midwife-led unit at Lewisham Hospital will be able to deal with a minimum of 10% of existing activity and up to 60% of current activity.

4) The new smaller Lewisham Hospital A&E can continue to see up to 75% of those currently attending Lewisham A&E.

The responses I received stated:

3) The National Institute of Health and Clinical Excellence suggest up to 60% of women in England are suitable to give birth in a free-standing midwife-led unit. However, based on historic patient choice elsewhere in London, and an assumption that around half of the patients currently using the co-located midwife-led unit at Lewisham will continue to attend a stand-alone unit, the TSA has modelled that around 10% of the births projected to take place at University Hospital Lewisham in 2015/16 will still take place there.

4) [Bruce Keogh’s] estimate that the site could manage nearer to 75% of activity with these changes is based on the Lewisham Healthcare NHS Trust’s admissions data and flowing from this that the A&E would have the clinical capacity to safely treat this number of patients.

Neither response provides the exact calculations used to reach these figures as requested in the FoI request. For clarity, I will outline the information missing from the responses.

Question 3:

- “based on historic patient choice elsewhere in London” – what historic patient choice is this referring to? Over what period? What areas in London is this referring to? Where has this data been sourced from?

- “and an assumption that around half of the patients currently using the co-located midwife-led unit at Lewisham will continue to attend a stand-alone unit” – what clinical and/or statistical data is this assumption based on? Where has this data been sourced from?

- “the TSA has modelled that around 10% of the births projected to take place at University Hospital Lewisham in 2015/16 will still take place there” – what is the exact calculation used to reach this figure? What are the underlying figures? This calculation should be sufficiently detailed to clearly demonstrate how and why the TSA reached this 10% figure, rather than, say, 5%, 8% or 15%.

Question four

“[Bruce Keogh’s] estimate that the site could manage nearer to 75% of activity with these changes is based on the Lewisham Healthcare NHS Trust’s admissions data”– what does this admissions data state? How was this data used to reach the 75% figure?

- “and flowing from this that the A&E would have the clinical capacity to safely treat this number of patients” – what clinical and/or scientific data is this based on? Where was this data sourced from?

Again, what are the underlying FIGURES used to reach the 75% figure? I would like to know, under the Freedom of Information Act, the EXACT calculation used by Bruce Keogh. This calculation should be sufficiently detailed to clearly demonstrate how and why he reached this 75% figure, as opposed to, say, 40%, 60% or 90%.

I trust that the Department of Health already has all this information, or else the downgrade of Lewisham Hospital’s services would never ever have been approved. As such, I look forward to a speedy response.

8 April 2013

Department of Health

15 April 2013

Dear Ms Hawthorne

I understand that you have not received an acknowledgement of your request for an Internal Review of your Freedom of Information request (Our reference: DE00000756987). We are not sure why this has happened and can only apologise.

I can confirm that the Department has received your request. This is currently being processed by a member of the Freedom of Information team, who will respond to you in due course.

Best practice on timeliness for IR responses is within 20 working days, which means that, in this case, we aim to respond to you by 2 May.

Department of Health

30 April 2013

Thank you for your phone call this afternoon regarding the Internal Review of your Freedom of Information request DE00000760490.

I am sorry that you have not received your Internal Review response within the 20 day timeframe, which the Information Commissioner's Office considers to be best practice. The Department aims to complete its Internal Reviews within 20 working days but in some cases we do require more time.

Our deliberations on both your Internal Reviews are continuing - please be assured that we will aim to reply to case DE00000760490 by 7 May and to case DE00000756987 as soon as possible

Department of Health

1 May 2013

Internal Review of case DE00000756987

Dear Ms Hawthorne

I am writing to update you on the progress of your internal review request of case DE00000756987.

Further to the email we sent to you yesterday, I am writing to confirm that we will be unable to respond to your review request within the 20 day timeframe, which the Information Commissioner considers to be best practice.

Please accept our apologies for this delay. We will respond to your request as soon as possible.

Department of Health

22 May 2013

Dear Ms Hawthorne,

I would like to apologise for the time it has taken us to respond to your internal review request, 756987R. I would like to assure you that we are actively working on this case as a priority and will respond as soon we can.

Whilst there's no legal requirement in the FOI Act to respond to internal reviews within a specific time limit, best practice is to respond within 20 days.

In the vast majority of cases, we reply to internal reviews within 20 days. However, there are some cases that require more than 20 days to consider and this is one of those cases.

From: S Hawthorne

22 May 2013

Dear Ms Paddy,

As stated several times on the phone, I am aware that the 20-day limit is best practice guidance, not a statutory limit.

The Information Commissioner also states that:

"In view of all the above the Commissioner considers that a reasonable time for completing an internal review is 20 working days from the date of the request for review. There may be a small number of cases which involve exceptional circumstances where it may be reasonable to take longer. In those circumstances, the public authority should, as a matter of good practice, notify the requester and explain why more time is needed."

I have yet to receive any explanation as to the reason for the delay. Could you please provide an explanation?

I would also like to draw your attention to the ICO's comment that:

"In our view, in no case should the total time taken exceed 40 working days."

I assume you're aware that it's now been 35 working days since I filed the internal review request.

From: S Hawthorne

23 May 2013

Dear Department of Health,

This response does not answer my question r.e question 4. I asked for the clinical and statistical evidence used to come to the 75% figure given by Bruce Keogh. This has not been given. If the DoH does not have any such evidence, this should be explicitly stated in the response.